Antibiotics and Your Kids: Overprescribed?

How many parents, when they take their child to the doctor because of an ear infection or a cold, expect to get antibiotics? I’ve seen a fascinating variety of patients and illnesses during my ten years as a family medicine doctor, but this topic of antibiotic overuse is one issue that never seems to end. Time after time, I will have patients come in with common illnesses such as the common cold; ear and sinus infections; and bronchitis, and I would often conclude that the patient has an infection from a virus and not a bacteria. Thus, I would not prescribe antibiotics and would give them mostly over-the-counter medicines to help their symptoms. Many people are reassured by my exam and explanation, but quite a few are disappointed or even angry because I didn’t fulfill their expectations of needing antibiotics. This is a very common cause of patient-doctor friction, especially among pediatricians and family medicine doctors when dealing with children. The major question is: when does a child really need antibiotics?

The simple answer is: usually not nearly as much as you may think. Let’s take the common cold for example. The common cold symptoms of a low fever, wet cough and runny nose are usually caused by a family of viruses and not bacteria. The typical course is 3-4 days of these symptoms, with the cough usually the last to resolve many days later. The commonly assumed “warning sign” of colored or greenish runny nose does not mean this infection is bacterial; it only means your body’s white cells are fighting an infection, which again most likely is viral. So in most of these cases, the antibiotic doesn’t help fight this infection at all.

Antibiotic overuse is a serious problem not only because the medicine isn’t properly treating your child; it also could cause common side effects such as diarrhea and rash, or more serious allergic reactions such as allergic shock or even death. Plus, your child’s body may become resistant to this antibiotic in the future, when they may actually need the medicine to fight a real bacterial infection.

The American Academy of Pediatrics and the American Academy of Family Medicine both agree that antibiotic overuse is a serious problem with children’s illnesses, and they are dangerously over-prescribed for simple illnesses — but especially for ear infections. Many times in this scenario, the infection again is caused by a virus, and thus a week of antibiotics is not helpful at all. Fortunately, thanks to these Academies’ public education campaigns, doctors have been much more aggressive these last few years in cutting back on prescribing antibiotics for ear infections.

So what can we all do about this? I think one major fault lies with the doctors; we really need to do a much better job convincing our patients or their parents that antibiotics are only for serious bacterial infections. Perhaps doctors should even rename “antibiotics” to “antibacterials” to help patients distinguish the difference; after all, there is a class of “antivirals” for specific viruses such as HIV, influenza or hepatitis. Another technique is to prescribe the antibiotic but to have the parents wait before buying the medicine; after 24 to 48 hours, if the child is clearly worsening, then the parents can choose to fill the prescription. This can be a nice win-win for doctor and patient, as it gives the parents a bit more control, and it also gives the child time to recover without antibiotics.